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HSR Citation Abstract

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Puzzling pieces: validating the VA long term care home and community based care projections

Kinosian B, Stallard E, Canamucio A, Polsky D, Manton K. Puzzling pieces: validating the VA long term care home and community based care projections. Paper presented at: American Geriatrics Society Annual Meeting; 2009 May 1; Chicago, IL.

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Objective: Evaluation of LTC projections for HCBC using available CMS and VA administrative data. Methods: We developed a static projection model, using the 2002 enrolled veteran population stratified by age/gender/priority/VISN. We imputed disability and marital status from the 1999 National Long Term Care Survey (NLTCS) for those age 65+, and the National Health Interview Survey for those < 65.We constructed HCBC use rates for each age/gender/marital status/priority/ disability level from the 1999 NLTCS for those aged 65+ and from the 2000 National Home Care and Hospice Survey (NHHS) for those age < 65. For validation, we matched the 2004 NLTCS with the VA enrollment file, and summarized VA HCBC use among matched survey respondents.We matched the 2004 OASIS file with the 2004 enrollment file, to obtain skilled home health episodes, and imputed Average Daily Census (ADC) based on length of episode and visits. HCBC services were operationalized as Medical (Home Based Primary Care (HBPC),Skilled home health, Hospice) and Supportive(other home health,ADHC, In-home Respite). Additional supportive HCBC from the NLTCS included Assisted Living and formal help. ADC was calculated by using current VA workload recording procedures. Results:Validation data were reliably available for age 65+, representing 118,300/162,000 ADC (73%). Actual VA supplied HCBC ADC was 17,471,(14% of total) and 16,871 estimated from the NLTCS cohort.Total utilization, using the NLTCS cohort was 118,641 (Medical HCBC ADC 44,962/Supportive HCBC ADC 73,679), and 122,888 using VA/OASIS utilization for Medical HCBC. For HBPC, VA supplied 59.8% of total ADC using the NLTCS cohort (12,041/20,112), indicating frail, enrolled veterans receive a large amount of in-home primary care from non-VA providers. Hospice accounted for nearly 1/4 of Medical HCBC (12,800). Non-Federal sources paid for 46% of formal ADC, while only 26% of ADC for those with 3+ ADL dependencies were provided by formal (paid) help. In 2007, actual VA supplied Medical HCBC was 42% of model projections. Conclusions: Enrolled veterans receive a large amount of HCBC services, most is informal, with projections closely matching actual ADC, of which VA provided 31% of Medical but 19% of total HCBC, and 59% of in-home primary care in 2004.

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